自身免疫性肝炎和原发性胆汁性胆管炎患者甲状腺功能变化及其对治疗应答的影响*

doi:10.3969/j.issn.1672-5069.2024.01.014

摘要/Abstract

摘要： 目的分析自身免疫性肝炎(AIH)和原发性胆汁性胆管炎(PBC)患者甲状腺功能、抗甲状腺抗体变化及其对治疗应答的影响。方法 2020年1月～2022年1月我院诊治的AIH患者30例、PBC患者28例和同期健康体检者32例,分别给予患者标准的免疫抑制或熊去氧胆酸治疗。常规检测血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,采用放射受体法检测血清抗甲状腺素受体抗体(TRAb)、抗甲状腺过氧化物酶抗体(TPO-Ab)、抗甲状腺球蛋白抗体(TGAb)、甲状腺素结合球蛋白(TBG)和甲状腺球蛋白(TG)。结果 AIH组血清FT3和FT4水平分别为(4.2±0.2)pmol/L和(13.8±1.9)pmol/L,PBC组分别为(4.3±0.3)pmol/L和(13.9±1.3)pmol/L,均显著低于健康人【分别为(4.9±0.6)pmol/L和(15.9±4.2)pmol/L,P＜0.05】,而AIH组和PBC组血清TSH水平分别为(3.8±1.2)mIU/L和(3.7±0.5)mIU/L,均显著高于健康人【(2.6±0.5)mIU/L,P＜0.05】;AIH组血清TPO-Ab和TG阳性率分别为33.3%和26.7%,PBC组分别为39.3%和25.0%,均显著高于健康人的9.4%和3.1%(P＜0.05);经过1年的治疗,AIH组生化学应答率为66.7%,PBC组为75.0%;两种疾病应答组血清FT3和FT4水平显著高于未应答组,而血清TSH水平及TPO-Ab和TG阳性率显著低于未应答组,差异有统计学意义(P＜0.05)。结论 AIH和PBC患者都可能存在甲状腺功能减退,并影响治疗应答,临床应予以重视筛查和处理。

关键词: 自身免疫性肝炎, 原发性胆汁性胆管炎, 甲状腺功能, 抗甲状腺抗体, 治疗, 应答

Abstract: Objective The study was conducted to analyze the changes of thyroid functions and their impact on response to standardized therapy in patients with autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). Methods 30 patients with AIH, 28 patients with PBC and 32 volunteers were recruited in our hospital between January 2020 and January 2022, and the patients with AIH or with PBC were treated by standardized immunosuppression or ursodeoxycholic acid therapy. Serum total-triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine T4 (FT4) and thyroid-stimulating hormone (TSH) levels were routinely detected. Serum anti-thyroglobulin antibodies (TRAb), thyroid-peroxidase antibody (TPO-Ab), anti-thyroglobulin antibodies (TGAb), thyroxine-binding globulin (TBG) and thyroglobulin (TG) were also determined by radioimmunoassay. Results Serum FT3 and FT4 levels in patients with AIH were (4.2±0.2)pmol/L and (13.8±1.9)pmol/L, and in patients with PBC were (4.3±0.3)pmol/L and (13.9±1.3)pmol/L, significantly lower than [(4.9±0.6)pmol/L and (15.9±4.2)pmol/L, respectively, P＜0.05], while serum TSH levels in patients with AIH and in with PBC were (3.8±1.2)mIU/L and (3.7±0.5)mIU/L, significantly higher than [(2.6±0.5)mIU/L, P＜0.05] in healthy volunteers; serum TPO-Ab and TG positive rates in patients with AIH were 33.3% and 26.7%, and in patients with PBC were 39.3% and 25.0%, all significantly higher than 9.4% and 3.1%(P＜0.05) in healthy individuals; at the end of one-year treatment, the response rates to treatment in patients with AIH was 66.7% and in patients with PBC was 75.0%; serum FT3 and FT4 levels in responders no matter in AIH or PBC were significantly higher than, while serum TSH levels as well as serum TPO-Ab and TG positive rates were much lower than in non-responders(P＜0.05). Conclusion The hypothyroidism could occur in patients with autoimmune liver diseases, which might influence the response to standardized therapy, and warrants clinical careful surveillance.

Key words: Autoimmune hepatitis, Primary biliary cholangitis, Thyroid functions, Anti-thyroglobulin antibodies, Therapy, Response

闫玉婷, 贾桂, 孟琴, 高欣欣. 自身免疫性肝炎和原发性胆汁性胆管炎患者甲状腺功能变化及其对治疗应答的影响^*[J]. 实用肝脏病杂志, 2024, 27(1): 52-55.

Yan Yuting, Jia Gui, Meng Qin, et al. Thyroid functions and their impact on response to standardized therapy in patients with autoimmune hepatitis and primary biliary cholangitis[J]. Journal of Practical Hepatology, 2024, 27(1): 52-55.

参考文献

[1] 崔娜娜, 马雄, 王绮夏. 原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征伴发丙型肝炎病毒感染一例. 中华传染病杂志, 2021, 39(5): 304-305.
[2] Younossi ZM, Bernstein D, Shiffman ML, et al. Diagnosis and management of primary biliary cholangitis. Am J Gastroenterol, 2019, 114(1): 48-63.
[3] Mammen JSR, Cappola AR. Autoimmune thyroid disease in women. JAMA, 2021, 325(23): 2392-2393.
[4] Kisseleva T, Brenner D. Molecular and cellular mechanisms of liver fibrosis and its regression. Nat Rev Gastroenterol Hepatol, 2021, 18(3): 151-166.
[5] Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proc Nutr Soc, 2019, 78(1): 34-44.
[6] 王绮夏, 蒋翔, 连敏, 等. 2015年欧洲肝病学会临床实践指南:自身免疫性肝炎. 临床肝胆病杂志, 2015, 31(12): 2000-2019.
[7] 中华医学会肝病学分会、消化病学分会、感染病学分会.胆汁淤积性肝病诊断和治疗共识(2015年).实用肝脏病杂志,2016,19(6):Ⅰ-ⅩⅠ.
[8] Wang CR, Tsai HW. Autoimmune liver diseases in systemic rheumatic diseases. World J Gastroenterol, 2022, 28(23): 2527-2545.
[9] Trivedi PJ, Hirschfield GM. Recent advances in clinical practice: epidemiology of autoimmune liver diseases, Gut, 2021, 70(10): 1989-2003.
[10] Moran C, Schoenmakers N, Visser WE, et al. Genetic disorders of thyroid development, hormone biosynthesis and signalling. Clin Endocrinol (Oxf), 2022, 97(4): 502-514.
[11] Lei Z, Zeng B, Wu L, et al. Free triiodothyronine and free thyroxine hormone levels in relation to breast cancer risk: a meta-analysis. Endokrynol Pol, 2022, 73(2): 309-315.
[12] Štěpánek L, Horáková D, Štěpánek L, et al. Free triiodothyronine/free thyroxine (ft3/ft4) ratio is strongly associated with insulin resistance in euthyroid and hypothyroid adults: a cross-sectional study. Endokrynol Pol, 2021, 72(1): 8-13.
[13] Duan J, Xu P, Luan X, et al. Hormone- and antibody-mediated activation of the thyrotropin receptor. Nature, 2022, 609(7928): 854-859.
[14] 周莉莉, 楼晓佳, 吴月丹, 等. 应用ROC曲线探讨血清甲状腺球蛋白抗体、抗甲状腺过氧化物酶抗体、TSH受体抗体在分化型甲状腺癌诊断中的临床价值. 中国卫生检验杂志, 2021, 31(6): 735-738.
[15] Bliddal S, Derakhshan A, Xiao Y, et al. Association of thyroid peroxidase antibodies and thyroglobulin antibodies with thyroid function in pregnancy: an Individual participant data meta-analysis. Thyroid, 2022, 32(7): 828-840.
[16] 徐艳, 于秉楠, 武剑. 自身免疫性肝炎和原发性胆汁性肝硬化患者自身免疫性甲状腺疾病流行率调查. 实用肝脏病杂志, 2022, 25(1): 42-45.
[17] Rodia R, Meloni PE, Mascia C, et al. Direct-acting antivirals used inHCV-related liver disease do not affect thyroid function and autoimmunity. J Endocrinol Invest, 2023, 46(2): 359-366.
[18] Weber S, Benesic A, Rotter I, et al. Early alt response to corticosteroid treatment distinguishes idiosyncratic drug-induced liver injury from autoimmune hepatitis. Liver Int, 2019, 39(10): 1906-1917.
[19] de Veer RC, Harms MH, Corpechot C, et al. Liver transplant-free survival according to alkaline phosphatase and globe score in patients with primary biliary cholangitis treated with ursodeoxycholic acid. Aliment Pharmacol Ther, 2022, 56(9): 1408-1418.
[20] Tanaka A. Current understanding of primary biliary cholangitis. Clin Mol Hepatol, 2021,27(1):1-21.

自身免疫性肝炎和原发性胆汁性胆管炎患者甲状腺功能变化及其对治疗应答的影响^*

Thyroid functions and their impact on response to standardized therapy in patients with autoimmune hepatitis and primary biliary cholangitis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	陈从新, 陈曦, 王莉苹, 赵秋香, 刘颖, 周海洋. 糖皮质激素在肝病治疗中的应用[J]. 实用肝脏病杂志, 2024, 27(3): 321-323.
[2]	赵玉雯, 朱传龙. 肝硬化营养不良及肌少症治疗研究进展[J]. 实用肝脏病杂志, 2024, 27(3): 324-328.
[3]	罗良德, 任成果, 王守军, 邓颖春. 恩替卡韦联合多烯磷脂酰胆碱治疗慢性乙型肝炎合并NASH患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 333-336.
[4]	周安琪, 孟舒婷, 吴应冬, 张弦. 接受核苷(酸)类似物抗病毒的慢性乙型肝炎患者发生低病毒血症危险因素分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 337-340.
[5]	程艳洁, 王鹏飞, 李峻. 水飞蓟素联合复方蛋氨酸胆碱治疗酒精性肝炎患者疗效及其对血清肝纤维化指标的影响^*[J]. 实用肝脏病杂志, 2024, 27(3): 349-352.
[6]	金伯旬, 张丽, 娜仁图雅, 齐丽艳, 边新渠, 刘海霞, 王鑫, 栗光明. 急性表现与非急性表现的自身免疫性肝炎患者临床和肝组织病理学特征分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 366-369.
[7]	刘恋, 吉飞跃, 陈诺儿. 自身免疫性肝炎患者外周血单个核细胞CD6及其配体激活的白细胞粘附分子水平变化临床价值研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 370-373.
[8]	徐秋萍, 黄彬, 陈敏, 余静. 泼尼松与泼尼松联合硫唑嘌呤治疗自身免疫性肝炎患者外周血MDSCs百分比、肝组织白细胞介素-35和血清CD38水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2024, 27(3): 374-377.
[9]	姜正伟, 周冰清, 汤洁, 蒋蓓莉. 血清抗糖蛋白210抗体阳性的原发性胆汁性胆管炎患者临床特征分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 378-381.
[10]	李菊兰, 张华堂, 郑怡娟, 余雪平, 邓勇, 苏智军. 恩替卡韦联合扶正化瘀片治疗乙型肝炎肝硬化患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 402-405.
[11]	蔡峻岭, 苏立, 郝丽, 赵敏, 裴旭东. 基于索磷布韦的直接抗病毒药物治疗丙型肝炎肝硬化患者疗效评价^*[J]. 实用肝脏病杂志, 2024, 27(3): 406-409.
[12]	闫振, 赵博文, 林国英, 殷和良. 影像学三维可视化技术指导肝切除术治疗肝细胞癌患者临床疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 438-441.
[13]	李玮健, 刘昕, 舒红艳. 超声引导下聚桂醇与无水乙醇注射硬化治疗肝囊肿患者疗效比较研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 450-453.
[14]	王苓入, 苏虹, 郝晓炜, 李娜. 超声引导下PTGD联合聚桂醇硬化治疗单纯性肝囊肿患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 454-457.
[15]	徐旭, 施漪雯, 范建高. 肝豆状核变性治疗现状与展望^*[J]. 实用肝脏病杂志, 2024, 27(3): 477-480.